Clinical Question: Is a diagnosis of migraine more appropriate for patients who have headaches attributed to sinus symptoms?

Setting: Outpatient (primary care)

Study Design: Cohort (prospective)

Synopsis: This study explored the labeling of patients with frequent headaches. The investigators screened patients at 452 North American primary care sites and identified 2,991 patients with at least six self-described or physician-diagnosed “sinus headaches” during the six months before screening. They excluded patients with a diagnosis of migraine, those who had “radiologic evidence of sinus infection,” and those who had fever or purulent nasal discharge associated with their headaches.

Patients were then evaluated to determine whether they met International Headache Society criteria for migraine. However, clinicians making the migraine diagnosis were aware of the patients’ previous diagnoses and their response to medication. There is a real risk that the clinicians saw what they wanted to see and, thus, found more migraines than actually existed, especially because this study was sponsored by the manufacturer of a migraine drug. Eighty-eight percent of these patients met criteria for migraine; yet, 84 percent also reported sinus pressure, and 82 percent reported sinus pain. This study probably overestimates the rate of misdiagnosis.

Bottom Line: Patients with frequent sinus headaches may actually have migraine headache. A more useful study would determine what proportion of patients with sinus headaches actually respond to migraine-specific treatment. A diagnosis, whether correct or not, is unimportant unless it leads to appropriate management decisions, a reality sometimes forgotten by health care professionals. (Level of Evidence: 2b)